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HEALTH INFORMATION MANAGEMENT (HIM) IN THE CONTROL OF MEDICAL CLAIMS ERRORS
Abstract
Preparing and submitting medical claims to health care providers is a crucial component in hospital finance. Owing to the complexity of the process, medical claims errors may result in financial issues. Our objective is to examine the process of preparing and submitting medical claims in the distinguished Healthpoint Hospital/Abu Dhabi, also the reasons for rejection of medical claims so as to focus in control hospital’s medical claims errors. The cases of claim rejection between the years 2014-2018 according to the hospital records are as follows: 2018 (January – May) 5%, 2017 4.4%, 2016 8%, 2015 & 2014 24%. Other cases of medical claims regarding Vitiligo (37 cases), obesity (14 cases), and Audiometry (23 cases) are also reviewed. It seems that the most common medical billing errors are related to technical and nontechnical errors. The strategy of controlling medical claims errors is designed in the hospital by applying key performance indicators (KPI) that demonstrate how effectively the hospital is achieving the key business objectives. The result proves that the strongest electronic system and applying the new business strategies led to reducing the rejections of medical claims due to mistakes.
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Hospital billing process is a crucial component for hospital management. Due to the complexity of the hospital billing processes, billing errors may result in costly financial losses. In Turkish social security system, Social Security Institution (SSI) provides health insurance, which ensures maintenance of health statuses of individuals and the financing of costs that arise in case the individuals experience health risks. Accordingly, SSI developed billing procedures for hospitals in financing the healthcare needs of individuals. Hospitals need to comply with the standards set by SSI in order to prevent stoppages and fines in financing their costs. In the following, Hacettepe University Hospitals’, where 95 % of the healthcare service payments are made by the SSI, are studied. Nevertheless, there is a huge amount of financial losses from SSI because of the errors occurring during billing process. Here, the aim is to minimize Hacettepe University Hospitals’ billing errors. To realize this aim, Lean Six Sigma framework and problem solving methods of DMAIC are used. The billing process of the hospital is studied first and critical points are determined. After meetings with the hospital IT personnel and hospital administration, some important data, including the past billing errors are retrieved. The main billing errors, their reasons and the financial costs of the errors are analyzed with statistical and graphical tools. To solve the problems and remove the errors, work flow and standard operating procedures of the hospital billing process is prepared.
Study.com. Retrieved from Health Information Management: Definition
- M Shapland
Shapland, M. (n.d.). Study.com. Retrieved from Health Information Management: Definition, Use
& Ethics: https://study.com/academy/lesson/health-information-management-definition-useethics.html.
NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances. USA: NerdWallet Health
- C Lamontagne
Lamontagne, C. (2014). NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy
Advances. USA: NerdWallet Health, Oct.8.2014
Retrieved from The Danger Lurking in Your Medical Bills
- K Hobson
HOBSON, K. (2015, April 21). Retrieved from The Danger Lurking in Your Medical Bills-Money:
http://time.com/money/3819569/medical-billing-errors/
How to handle medical billing errors. Reuters
- M Lipka
Lipka, M. (2013). How to handle medical billing errors. Reuters, Wealth July 3, 2012
Retrieved from 10 most popular plastic surgery procedures
- Cbs News
CBS News. (n.d.). Retrieved from 10 most popular plastic surgery procedures:
https://www.cbsnews.com/pictures/10-most-popular-plastic-surgery-procedures/5/
Rev cycle intelligence. Retrieved from 4 Medical Billing Issues Affecting Healthcare Revenue Cycle
- J Belliveau
Belliveau, J. (2016, August 2). Rev cycle intelligence. Retrieved from 4 Medical Billing Issues
Affecting Healthcare Revenue Cycle: https://revcycleintelligence.com/news/4-medical-billingissues-affecting-healthcare-revenue-cycle.
American Medical Association National Health Insurer Report Card
- Ama. By Thomas Sullivan
AMA. By Thomas Sullivan (2013). American Medical Association National Health Insurer Report
Card. USA: American Medical Association, Jul 18, 2013
A Local Health Department Perspective). Common Medical Billing Mistakes and Solutions. USA: Illinois Public Health Association
- Ncg Medical
- Inc
NCG Medical, Inc. 2016 (A Local Health Department Perspective). Common Medical Billing
Mistakes and Solutions. USA: Illinois Public Health Association.